Partial breast irradiation: a review of techniques and indications

Stewart, Alexandra J.; Khan, Atif J.; Devlin, Phillip M.

doi:10.1259/bjr/11505970

Cited by 24 publications

(16 citation statements)

References 60 publications

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“…1,2) Several distinct treatment techniques have been used to deliver this therapy, including multicatheter interstitial brachytherapy, single-entry intracavitary brachytherapy catheters, intraoperative techniques (x-rays and electrons), and external radiation with photons and/or protons. [3][4][5][6][7] Each modality has been reported ad-vantages and disadvantages, depending on the patient's anatomy and preference, as well as the resources available at a particular radiation oncology facility. 5,8,9) External beam radiation therapy (EBRT), which can be delivered noninvasively, is most common type to deliver PBI using the standard linear accelerator (linac) found in all radiation oncology facilities.…”

Section: Introductionmentioning

confidence: 99%

Effect of Low Magnetic Field on Dose Distribution in the Partial-Breast Irradiation

et al. 2015

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The aim of this study is to investigate the effect of low magnetic field on dose distribution in the partial-breast irradiation (PBI). Eleven patients with an invasive early-stage breast carcinoma were treated prospectively with PBI using 38.5 Gy delivered in 10 fractions using the ViewRay Ⓡ system. For each of the treatment plans, dose distribution was calculated with magnetic field and without magnetic field, and the difference between dose and volume for each organ were evaluated. For planning target volume (PTV), the analysis included the point minimum (Dmin), maximum, mean dose (Dmean) and volume receiving at least 90% (V90%), 95% (V95%) and 107% (V107%) of the prescribed dose, respectively. For organs at risk (OARs), the ipsilateral lung was analyzed with Dmean and the volume receiving 20 Gy (V20 Gy), and the contralateral lung was analyzed with only Dmean. The heart was analyzed with Dmean, Dmax, and V20 Gy, and both inner and outer shells were analyzed with the point Dmin, Dmax and Dmean, respectively. For PTV, the effect of low magnetic field on dose distribution showed a difference of up to 2% for volume change and 4 Gy for dose. In OARs analysis, the significant effect of the magnetic field was not observed. Despite small deviation values, the average difference of mean dose values showed significant difference (p＜0.001), but there was no difference of point minimum dose values in both sehll structures. The largest deviation for the average difference of Dmax in the outer shell structure was 5.0±10.5 Gy (p=0.148). The effect of low magnetic field of 0.35 T on dose deposition by a Co-60 beam was not significantly observed within the body for PBI IMRT plans. The dose deposition was only appreciable outside the body, where a dose build-up due to contaminated electrons generated in the treatment head and scattered electrons formed near the body surface.

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Section: Introductionmentioning

confidence: 99%

Effect of Low Magnetic Field on Dose Distribution in the Partial-Breast Irradiation

et al. 2015

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“…Electron-only linear accelerators have been used for this approach, and recent mobile devices can be used in unmodified theatres if the workload is limited or thick mobile shielding panels are used [2][3][4]. The Intrabeam system (Carl Zeiss Surgical, Oberkochen, Germany) is a compact X-ray unit used for intra-operative partial breast irradiation [5][6][7][8], currently in an international randomised controlled trial (Targit) [9,10]. It generates photons using an accelerating voltage of 50 kVp.…”

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confidence: 99%

Radiation protection for an intra-operative X-ray device

Eaton

Gonzalez²,

Duck³

et al. 2011

BJR

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Objectives: Therapeutic partial breast irradiation can be delivered intra-operatively using the Intrabeam 50 kVp compact X-ray device. Spherical applicators are added to the source to give an isotropic radiation dose. The low energy of this unit leads to rapid attenuation with distance, but dose rates are much greater than for diagnostic procedures. Methods: To investigate the shielding requirements for this unit, attenuation measurements were carried out with manufacturer-provided tungsten-rubber sheets, lead, plasterboard and bricks. A prospective environmental dose rate survey was also conducted in the designated theatre. Results: As a result of isotropic geometry, the scattered dose around shielding can be 1% of primary and thus often dominates measured dose rates compared with transmission. The absorbed dose rate of the unshielded source at 1 m was 11.6 mGy h 21 but this was reduced by 95% with the shielding sheets. Measured values for the common shielding materials were similar to reference data for the attenuation of a 50 kVp diagnostic X-ray beam. Two lead screens were constructed to shield operators remaining in the theatre and an air vent into a service corridor. A lead apron would also provide suitable attenuation, although a screen allows greater flexibility for treatment operators. With these measures, staff doses were reduced to negligible quantities. Survey measurements taken during patient treatments confirmed no additional measures were required, but the theatre should be a controlled area and access restricted.

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“…However, there has been much recent research into the potential for reduction of the irradiated area, to the partial breast or even just to the tumour bed. 75,76 IORT, once confined to advanced or recurrent disease, has been investigated as a minimally invasive method for delivering a single high dose to the tumour bed at the time of surgery.…”

Section: Breastmentioning

confidence: 99%

Electronic brachytherapy—current status and future directions

Eaton¹

2015

BJR

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In the past decade, electronic brachytherapy (EB) has emerged as an attractive modality for the treatment of skin lesions and intraoperative partial breast irradiation, as well as finding wider applications in intracavitary and interstitial sites. These miniature X-ray sources, which operate at low kilovoltage energies (,100 kV), have reduced shielding requirements and inherent portability, therefore can be used outside the traditional realms of the radiotherapy department. However, steep dose gradients and increased sensitivity to inhomogeneities challenge accurate dosimetry. Secondly, ease of use does not mitigate the need for close involvement by medical physics experts and consultant oncologists. Finally, further studies are needed to relate the more heterogeneous dose distributions to clinical outcomes. With these provisos, the practical convenience of EB strongly suggests that it will become an established option for selected patients, not only in radiotherapy departments but also in a range of operating theatres and clinics around the world.

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Partial breast irradiation: a review of techniques and indications

Cited by 24 publications

References 60 publications

Effect of Low Magnetic Field on Dose Distribution in the Partial-Breast Irradiation

Effect of Low Magnetic Field on Dose Distribution in the Partial-Breast Irradiation

Radiation protection for an intra-operative X-ray device

Electronic brachytherapy—current status and future directions

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